Provider First Line Business Practice Location Address:
10405 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:
98178-2546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-550-1149
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2008