Provider First Line Business Practice Location Address:
1966 6TH AVE. W
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-285-7755
Provider Business Practice Location Address Fax Number:
206-285-5469
Provider Enumeration Date:
04/18/2007