Provider First Line Business Practice Location Address:
2121 N 113TH ST
Provider Second Line Business Practice Location Address:
UNIT A
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-8502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-770-7464
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2016