Provider First Line Business Practice Location Address:
2235 FAIRVIEW AVE E #4
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:
98102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-230-5255
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2011