Provider First Line Business Practice Location Address:
5457 21ST 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:
98106-1412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-930-0174
Provider Business Practice Location Address Fax Number:
206-763-3277
Provider Enumeration Date:
06/21/2013