Provider First Line Business Practice Location Address:
210 W GALER 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:
98119-3332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-460-1407
Provider Business Practice Location Address Fax Number:
347-333-6645
Provider Enumeration Date:
12/12/2011