Provider First Line Business Practice Location Address:
216 1ST AVE S
Provider Second Line Business Practice Location Address:
#368
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98104-3441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-992-2097
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2007