Provider First Line Business Practice Location Address:
1726 S HANFORD ST
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:
98144-6311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-898-8278
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/10/2009