Provider First Line Business Practice Location Address:
9001 46TH AVE S UNIT B
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:
98118-5001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-906-8738
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/16/2012