Provider First Line Business Practice Location Address:
1618 S LANE ST STE 204
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-323-0868
Provider Business Practice Location Address Fax Number:
206-323-9206
Provider Enumeration Date:
04/25/2007