Provider First Line Business Practice Location Address:
6111 13TH AVE S
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:
98108-2705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-763-0288
Provider Business Practice Location Address Fax Number:
206-768-1296
Provider Enumeration Date:
02/12/2007