Provider First Line Business Practice Location Address:
1718 CALIFORNIA 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:
98116-1922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-223-6005
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2012