Provider First Line Business Practice Location Address:
3207 RAINIER 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:
98144-6031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-722-2205
Provider Business Practice Location Address Fax Number:
206-722-5457
Provider Enumeration Date:
09/25/2006