Provider First Line Business Practice Location Address:
4002 25TH 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:
98108-1511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-723-4891
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2010