Provider First Line Business Practice Location Address:
5224 WILSON AVE S
Provider Second Line Business Practice Location Address:
SUITE 101A
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98118-2587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-725-1820
Provider Business Practice Location Address Fax Number:
206-725-1890
Provider Enumeration Date:
06/04/2007