Provider First Line Business Practice Location Address:
2601 SW KENYON 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:
98126-8126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-252-9007
Provider Business Practice Location Address Fax Number:
206-743-3117
Provider Enumeration Date:
10/16/2012