Provider First Line Business Practice Location Address:
1422 SENECA 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:
98101-2830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-323-7659
Provider Business Practice Location Address Fax Number:
206-323-4668
Provider Enumeration Date:
10/09/2013