Provider First Line Business Practice Location Address:
5410 CALIFORNIA AVE SW
Provider Second Line Business Practice Location Address:
203
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98136-1562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-923-2053
Provider Business Practice Location Address Fax Number:
206-466-6656
Provider Enumeration Date:
02/19/2016