Provider First Line Business Practice Location Address:
2311 1/2 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:
98144-5020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-225-1674
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/21/2015