Provider First Line Business Practice Location Address:
225 12TH AVE S STE 103
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:
98144-1904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-322-6915
Provider Business Practice Location Address Fax Number:
206-568-0092
Provider Enumeration Date:
09/04/2007