Provider First Line Business Practice Location Address:
1765 15TH AVE. SOUTH
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:
98144-4211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-323-1710
Provider Business Practice Location Address Fax Number:
206-323-0418
Provider Enumeration Date:
07/30/2007