Provider First Line Business Practice Location Address:
1830 1/2 N 54TH ST
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:
98103-6122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-921-1435
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2007