Provider First Line Business Practice Location Address:
8311 BEACON AVE S
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:
98118-4323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-548-3168
Provider Business Practice Location Address Fax Number:
206-973-8778
Provider Enumeration Date:
02/27/2007