Provider First Line Business Practice Location Address:
910 18TH AVE EAST
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:
98112-3930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-623-1106
Provider Business Practice Location Address Fax Number:
206-329-8915
Provider Enumeration Date:
08/24/2006