Provider First Line Business Practice Location Address:
424 N 68TH ST UNIT B
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:
98103-5214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-498-6256
Provider Business Practice Location Address Fax Number:
206-895-4774
Provider Enumeration Date:
04/10/2007