Provider First Line Business Practice Location Address:
3515 E SPRING 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:
98122-5268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-972-7952
Provider Business Practice Location Address Fax Number:
206-329-7316
Provider Enumeration Date:
10/27/2006