Provider First Line Business Practice Location Address:
3414 W BLAINE ST
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:
98199-3952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-581-0351
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2012