Provider First Line Business Practice Location Address:
2715 23RD AVE S
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:
98144-5308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-229-1118
Provider Business Practice Location Address Fax Number:
206-329-7033
Provider Enumeration Date:
02/22/2012