Provider First Line Business Practice Location Address:
115 30TH AVE
Provider Second Line Business Practice Location Address:
B
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98122-6229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-501-7742
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/22/2013