Provider First Line Business Practice Location Address:
3620 E PROSPECT 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:
98112-4440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-322-6742
Provider Business Practice Location Address Fax Number:
206-322-6803
Provider Enumeration Date:
11/22/2010