Provider First Line Business Practice Location Address:
6121 12TH AVE NE
Provider Second Line Business Practice Location Address:
UNIT C
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98115-6703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-953-7688
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/12/2012