Provider First Line Business Practice Location Address:
818 12TH AVE
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:
98122-4410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-329-5255
Provider Business Practice Location Address Fax Number:
206-641-3231
Provider Enumeration Date:
12/27/2012