Provider First Line Business Practice Location Address:
5501 4TH AVE S
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98108-2447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-420-4934
Provider Business Practice Location Address Fax Number:
206-257-0372
Provider Enumeration Date:
10/13/2010