Provider First Line Business Practice Location Address:
4028 48TH AVE SW
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:
98116-3605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-419-1973
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/22/2011