Provider First Line Business Practice Location Address:
10618 2ND AVE SW
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:
98146-1560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-294-4197
Provider Business Practice Location Address Fax Number:
425-589-0531
Provider Enumeration Date:
11/18/2005