Provider First Line Business Practice Location Address:
2401 S IRVING 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:
98144-3727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-252-2779
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/29/2012