Provider First Line Business Practice Location Address:
2124 FOURTH AVE
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:
98121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-477-8256
Provider Business Practice Location Address Fax Number:
206-296-0184
Provider Enumeration Date:
10/19/2018