Provider First Line Business Practice Location Address:
2717 60TH AVE SW
Provider Second Line Business Practice Location Address:
UNIT C
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98116-4730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-725-1739
Provider Business Practice Location Address Fax Number:
206-725-2442
Provider Enumeration Date:
08/23/2005