Provider First Line Business Practice Location Address:
620 15TH 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:
98112-4524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-322-4552
Provider Business Practice Location Address Fax Number:
206-328-7944
Provider Enumeration Date:
03/15/2007