Provider First Line Business Practice Location Address:
2324 EASTLAKE AVE E
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:
98102-3345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-838-4590
Provider Business Practice Location Address Fax Number:
206-838-4599
Provider Enumeration Date:
04/21/2009