Provider First Line Business Practice Location Address:
2623 WESTERN AVE
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:
98121-1309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-441-2774
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2007