Provider First Line Business Practice Location Address:
3800 S MYRTLE 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:
98118-3529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-461-6981
Provider Business Practice Location Address Fax Number:
206-461-8581
Provider Enumeration Date:
11/08/2006