Provider First Line Business Practice Location Address:
3416 21ST AVE SOUTH
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:
98144-6710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-722-5753
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2007