Provider First Line Business Practice Location Address:
8312 22ND AVENUE NW
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:
98117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-594-4935
Provider Business Practice Location Address Fax Number:
206-593-5363
Provider Enumeration Date:
06/23/2017