Provider First Line Business Practice Location Address:
8915 14TH 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:
98108-4813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-764-4717
Provider Business Practice Location Address Fax Number:
206-764-8072
Provider Enumeration Date:
01/29/2007