Provider First Line Business Practice Location Address:
4519 CALIFORNIA AVE SW
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:
98116-4110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-937-0507
Provider Business Practice Location Address Fax Number:
206-236-4782
Provider Enumeration Date:
11/08/2006