Provider First Line Business Practice Location Address:
1101 W EMERSON ST
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:
98119-1316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-216-4534
Provider Business Practice Location Address Fax Number:
206-216-4539
Provider Enumeration Date:
05/22/2008