Provider First Line Business Practice Location Address:
1959 NE PACIFIC ST.
Provider Second Line Business Practice Location Address:
MEDICAL SPECIALTIES BOX 356166
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98109-4714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-598-4615
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2006