Provider First Line Business Practice Location Address:
5030 FAUNTLEROY WAY SW
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:
98136-1217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-420-1949
Provider Business Practice Location Address Fax Number:
206-420-1949
Provider Enumeration Date:
01/27/2010