Provider First Line Business Practice Location Address:
4900 RAINER AVE S.
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-760-7661
Provider Business Practice Location Address Fax Number:
206-760-1070
Provider Enumeration Date:
02/18/2014