Provider First Line Business Practice Location Address:
12610 DES MOINES MEMORIAL DR
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:
98168-2284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-243-7788
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2005