Provider First Line Business Practice Location Address:
2027 19TH 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:
98144-4407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-368-9120
Provider Business Practice Location Address Fax Number:
866-298-7689
Provider Enumeration Date:
09/25/2008