Provider First Line Business Practice Location Address:
1111 N 50TH 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:
98103-6636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-388-9096
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/15/2012