Provider First Line Business Practice Location Address:
319 W KINNEAR PL
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:
98119-3732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-662-2847
Provider Business Practice Location Address Fax Number:
206-544-8326
Provider Enumeration Date:
10/12/2006