Provider First Line Business Practice Location Address:
4727 DENVER AVE S
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:
98134-2316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-763-2626
Provider Business Practice Location Address Fax Number:
206-767-1397
Provider Enumeration Date:
09/22/2011