Provider First Line Business Practice Location Address:
4154 CALIFORNIA AVE SW
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:
98116-4102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-399-6198
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2008