Provider First Line Business Practice Location Address:
921 TERRY AVENUE
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:
98104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-689-6504
Provider Business Practice Location Address Fax Number:
206-689-8341
Provider Enumeration Date:
01/22/2007