Provider First Line Business Practice Location Address:
324 15TH AVE E
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98112-5802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-755-5556
Provider Business Practice Location Address Fax Number:
206-767-6276
Provider Enumeration Date:
12/20/2006