Provider First Line Business Practice Location Address:
3123 FAIRVIEW AVE E
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98102-3051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-595-5094
Provider Business Practice Location Address Fax Number:
206-458-6029
Provider Enumeration Date:
01/23/2007