Provider First Line Business Practice Location Address:
4800 S HENDERSON ST
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:
98118-4981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-252-7607
Provider Business Practice Location Address Fax Number:
206-743-3175
Provider Enumeration Date:
09/12/2016