Provider First Line Business Practice Location Address:
1211 E ALDER 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:
98122-5553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-205-9571
Provider Business Practice Location Address Fax Number:
206-205-9418
Provider Enumeration Date:
08/24/2011