Provider First Line Business Practice Location Address:
611 MAYNARD AVE S
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:
98104-2920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-621-8883
Provider Business Practice Location Address Fax Number:
206-621-9328
Provider Enumeration Date:
07/05/2011