Provider First Line Business Practice Location Address:
125 16 TH AVE E
Provider Second Line Business Practice Location Address:
CSB 545
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-326-3769
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/18/2019