Provider First Line Business Practice Location Address:
4333 12TH AVE NE # 1
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:
98105-5906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-632-7623
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2007