Provider First Line Business Practice Location Address:
1100 19TH 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:
98112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-324-0664
Provider Business Practice Location Address Fax Number:
206-324-1969
Provider Enumeration Date:
02/12/2008