Provider First Line Business Practice Location Address:
126 19TH AVE E
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98112-6315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-328-3050
Provider Business Practice Location Address Fax Number:
206-324-6517
Provider Enumeration Date:
09/18/2013