Provider First Line Business Practice Location Address:
4416 S BRANDON 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:
98118-2341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-721-3630
Provider Business Practice Location Address Fax Number:
206-721-3626
Provider Enumeration Date:
07/18/2005