Provider First Line Business Practice Location Address:
116 FAIRVIEW AVE. N
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:
98109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-254-1456
Provider Business Practice Location Address Fax Number:
971-206-5203
Provider Enumeration Date:
12/10/2012