Provider First Line Business Practice Location Address:
2011 18TH AVE E
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:
98112-2150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-328-0838
Provider Business Practice Location Address Fax Number:
206-328-8224
Provider Enumeration Date:
06/29/2006