Provider First Line Business Practice Location Address:
203 14TH AVE E
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:
98112-5223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-381-3473
Provider Business Practice Location Address Fax Number:
206-388-0913
Provider Enumeration Date:
12/20/2006