Provider First Line Business Practice Location Address:
4134 SW WEBSTER 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:
98136-2131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-849-1688
Provider Business Practice Location Address Fax Number:
206-937-2512
Provider Enumeration Date:
10/17/2007