Provider First Line Business Practice Location Address:
509 OLIVE WAY
Provider Second Line Business Practice Location Address:
1325 MEDICAL DENTAL BUILDING
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98101-1720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-622-5661
Provider Business Practice Location Address Fax Number:
206-937-8695
Provider Enumeration Date:
02/22/2007