Provider First Line Business Practice Location Address:
4712 7TH AVE NE # A
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:
98105-4726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-661-4448
Provider Business Practice Location Address Fax Number:
206-545-2773
Provider Enumeration Date:
07/30/2007