Provider First Line Business Practice Location Address:
1125 34TH AVE
Provider Second Line Business Practice Location Address:
#B
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98122-5138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-280-4147
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2013