Provider First Line Business Practice Location Address:
4520 42ND AVE SW
Provider Second Line Business Practice Location Address:
SUITE #23
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98116-4240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-938-1777
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2006