Provider First Line Business Practice Location Address:
3230 BEACON AVE S UNIT B
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:
98144-6331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-568-0903
Provider Business Practice Location Address Fax Number:
206-568-8164
Provider Enumeration Date:
07/11/2012