Provider First Line Business Practice Location Address:
1439 NW 62ND ST # A
Provider Second Line Business Practice Location Address:
UNIT A
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98107-2926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-618-6230
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2007