Provider First Line Business Practice Location Address:
4739 1/2 RAINIER AVE SOUTH
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:
98118-1657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-725-0119
Provider Business Practice Location Address Fax Number:
206-725-8829
Provider Enumeration Date:
11/03/2006