Provider First Line Business Practice Location Address:
2445 4TH AVE S
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98134-1939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-467-7202
Provider Business Practice Location Address Fax Number:
206-622-0616
Provider Enumeration Date:
06/06/2012