Provider First Line Business Practice Location Address:
1626 FEDERAL AVE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98102-4235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-329-1526
Provider Business Practice Location Address Fax Number:
206-329-1871
Provider Enumeration Date:
11/28/2006