Provider First Line Business Practice Location Address:
3815A 12TH 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:
98119-1307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-217-1716
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/23/2007