Provider First Line Business Practice Location Address:
4138 CALIFORNIA AVE SW
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98116-4928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-850-5575
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2016