Provider First Line Business Practice Location Address:
1936 4TH 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:
98119-2611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-818-4337
Provider Business Practice Location Address Fax Number:
206-238-9605
Provider Enumeration Date:
02/10/2006