Provider First Line Business Practice Location Address:
2204 FAIRMOUNT 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:
98126-2024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-371-0777
Provider Business Practice Location Address Fax Number:
855-271-7856
Provider Enumeration Date:
05/11/2007