Provider First Line Business Practice Location Address:
126 10TH AVE E
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:
98102-5708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-323-3277
Provider Business Practice Location Address Fax Number:
206-860-6807
Provider Enumeration Date:
12/27/2006