Provider First Line Business Practice Location Address:
1422 31ST 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:
98144-3910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-375-6559
Provider Business Practice Location Address Fax Number:
206-971-5020
Provider Enumeration Date:
06/18/2013