Provider First Line Business Practice Location Address:
8004 S 118TH 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:
98178-3852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-772-0347
Provider Business Practice Location Address Fax Number:
206-772-0374
Provider Enumeration Date:
08/09/2013