Provider First Line Business Practice Location Address:
2332 MINOR AVE E
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98102-3333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-714-7432
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2008