Provider First Line Business Practice Location Address:
4069 RAINIER AVE S STE A
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:
98118-1162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-721-2402
Provider Business Practice Location Address Fax Number:
206-725-9870
Provider Enumeration Date:
08/21/2006