Provider First Line Business Practice Location Address:
1624 42ND AVE E
Provider Second Line Business Practice Location Address:
#B
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98112-3216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-323-3704
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/07/2005