Provider First Line Business Practice Location Address:
613 19TH AVE E
Provider Second Line Business Practice Location Address:
SUITE 101A
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98112-4075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-465-1051
Provider Business Practice Location Address Fax Number:
253-761-1899
Provider Enumeration Date:
10/16/2007