Provider First Line Business Practice Location Address:
465 GARFIELD ST
Provider Second Line Business Practice Location Address:
4B
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98109-2965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-879-9042
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2012