Provider First Line Business Practice Location Address:
12419 RENTAN AVE S
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:
98178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-772-0088
Provider Business Practice Location Address Fax Number:
206-772-5420
Provider Enumeration Date:
08/17/2006