Provider First Line Business Practice Location Address:
2615 SW TRENTON ST
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:
98126-3745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-938-6738
Provider Business Practice Location Address Fax Number:
206-938-5217
Provider Enumeration Date:
01/16/2008