Provider First Line Business Practice Location Address:
502 RAINIER AVE. S.
Provider Second Line Business Practice Location Address:
STE #204
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-678-7064
Provider Business Practice Location Address Fax Number:
206-325-6516
Provider Enumeration Date:
03/20/2012