Provider First Line Business Practice Location Address:
12650 1ST 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:
98168-2617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-248-3006
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2007