Provider First Line Business Practice Location Address:
1915 25TH AVE S UNIT A
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:
98144-4708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-632-9522
Provider Business Practice Location Address Fax Number:
877-883-1876
Provider Enumeration Date:
02/16/2007