Provider First Line Business Practice Location Address:
1453 NW 54TH STREET
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-535-7464
Provider Business Practice Location Address Fax Number:
206-257-1854
Provider Enumeration Date:
05/06/2019