Provider First Line Business Practice Location Address:
2611 3RD AVE W UPPR
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:
98119-2331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-428-8512
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/19/2010