Provider First Line Business Practice Location Address:
509 OLIVE WAY
Provider Second Line Business Practice Location Address:
STE 1705 MEDICAL DENTAL BUILDING
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-467-6875
Provider Business Practice Location Address Fax Number:
206-470-0242
Provider Enumeration Date:
08/11/2006