Provider First Line Business Practice Location Address:
1463 E REPUBLICAN ST # 9A
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:
98112-4517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-568-1091
Provider Business Practice Location Address Fax Number:
206-568-1092
Provider Enumeration Date:
08/28/2008