Provider First Line Business Practice Location Address:
4343 15TH AVE S
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:
98108-1447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-762-1551
Provider Business Practice Location Address Fax Number:
206-267-1798
Provider Enumeration Date:
11/02/2006