Provider First Line Business Practice Location Address:
4543 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:
98118-1656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-722-8211
Provider Business Practice Location Address Fax Number:
206-722-3249
Provider Enumeration Date:
03/12/2007