Provider First Line Business Practice Location Address:
1421 34TH AVE STE 206
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:
98122-3333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-375-3616
Provider Business Practice Location Address Fax Number:
206-325-6305
Provider Enumeration Date:
01/18/2007