Provider First Line Business Practice Location Address:
4624 S HOLDEN 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:
98118-4122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-853-2869
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2012