Provider First Line Business Practice Location Address:
ORAL AND MAXILLOFACIAL SURGERY
Provider Second Line Business Practice Location Address:
1959 NE PACIFIC STREET, BOX 357134
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98195-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-849-8036
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/18/2012