Provider First Line Business Practice Location Address:
2008 15TH AVE S
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:
98144-4218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-215-3804
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2007