Provider First Line Business Practice Location Address:
1126 38TH 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:
98112-4434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-390-0887
Provider Business Practice Location Address Fax Number:
206-322-9766
Provider Enumeration Date:
03/02/2011