Provider First Line Business Practice Location Address:
4112 41ST AVE S
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:
98118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-328-4606
Provider Business Practice Location Address Fax Number:
206-760-4168
Provider Enumeration Date:
04/30/2007