Provider First Line Business Practice Location Address:
125 16TH 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:
98112-5211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-326-3530
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2005