Provider First Line Business Practice Location Address:
3703 S EDMUNDS ST
Provider Second Line Business Practice Location Address:
#20
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98118-1728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-280-8613
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2010