Provider First Line Business Practice Location Address:
4711 44TH AVE SW STE C
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:
98116-4401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-317-4646
Provider Business Practice Location Address Fax Number:
888-240-5967
Provider Enumeration Date:
08/30/2012