Provider First Line Business Practice Location Address:
2132 44TH AVE SW
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:
98116-2102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-261-0160
Provider Business Practice Location Address Fax Number:
206-937-1933
Provider Enumeration Date:
03/27/2007