Provider First Line Business Practice Location Address:
511 28TH AVENUE EAST
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:
98112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-235-1768
Provider Business Practice Location Address Fax Number:
206-721-1768
Provider Enumeration Date:
12/26/2006