Provider First Line Business Practice Location Address:
1127 10TH AVE E STE 6
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:
98102-4377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-395-8825
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2012