Provider First Line Business Practice Location Address:
1631 15TH AVE W
Provider Second Line Business Practice Location Address:
STE 114
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-283-7033
Provider Business Practice Location Address Fax Number:
206-400-7652
Provider Enumeration Date:
03/22/2006