Provider First Line Business Practice Location Address:
2409 22ND AVE. EAST
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:
98112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-252-3307
Provider Business Practice Location Address Fax Number:
206-743-3150
Provider Enumeration Date:
11/28/2012