Provider First Line Business Practice Location Address:
305 S LUCILE 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:
98108-2435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-245-4760
Provider Business Practice Location Address Fax Number:
206-764-5147
Provider Enumeration Date:
03/23/2022