Provider First Line Business Practice Location Address:
10460 WATERS 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:
98178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-249-5532
Provider Business Practice Location Address Fax Number:
206-582-0811
Provider Enumeration Date:
09/10/2008