Provider First Line Business Practice Location Address:
117 E LOUISA ST
Provider Second Line Business Practice Location Address:
#449
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98102-3203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-860-0044
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/19/2008