Provider First Line Business Practice Location Address:
3810 S FERDINAND ST STE 201
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:
98118-1750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-743-8356
Provider Business Practice Location Address Fax Number:
206-829-8961
Provider Enumeration Date:
08/10/2009