Provider First Line Business Practice Location Address:
1916 23RD AVE S STE B
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:
98144-4616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-362-3344
Provider Business Practice Location Address Fax Number:
206-362-3444
Provider Enumeration Date:
05/28/2009