Provider First Line Business Practice Location Address:
611 12TH 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:
98144-2007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-834-4029
Provider Business Practice Location Address Fax Number:
206-834-4091
Provider Enumeration Date:
02/22/2012