Provider First Line Business Practice Location Address:
3828 S GRAHAM ST STE B
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:
98118-3119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-880-7768
Provider Business Practice Location Address Fax Number:
206-880-7767
Provider Enumeration Date:
10/29/2010