Provider First Line Business Practice Location Address:
5024 29TH AVE S
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:
98108-2111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-280-3657
Provider Business Practice Location Address Fax Number:
206-280-3657
Provider Enumeration Date:
03/27/2007