Provider First Line Business Practice Location Address:
9835 16TH AVE SW UNIT 101
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:
98106-2830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-763-8883
Provider Business Practice Location Address Fax Number:
206-768-8887
Provider Enumeration Date:
04/11/2007