Provider First Line Business Practice Location Address:
2021 MINOR AVE E STE 7
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:
98102-3588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-271-9689
Provider Business Practice Location Address Fax Number:
888-650-0141
Provider Enumeration Date:
03/15/2011