Provider First Line Business Practice Location Address:
1605 12TH AVE
Provider Second Line Business Practice Location Address:
22
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98122-2467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-375-9771
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2009