Provider First Line Business Practice Location Address:
3623 SW ALASKA ST
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:
98126-2732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-362-8674
Provider Business Practice Location Address Fax Number:
206-935-1425
Provider Enumeration Date:
07/10/2006