Provider First Line Business Practice Location Address:
611 12TH 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:
98144-1910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-324-9360
Provider Business Practice Location Address Fax Number:
206-324-4013
Provider Enumeration Date:
12/28/2006