Provider First Line Business Practice Location Address:
422 26TH AVE S
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:
98144-2335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-322-1050
Provider Business Practice Location Address Fax Number:
888-248-5232
Provider Enumeration Date:
08/19/2011