Provider First Line Business Practice Location Address:
2717 DEXTER AVE N
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:
98109-1914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-284-7012
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2019