Provider First Line Business Practice Location Address:
3202 15TH AVE W
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:
98119-1705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-708-7672
Provider Business Practice Location Address Fax Number:
206-327-9473
Provider Enumeration Date:
11/12/2007