Provider First Line Business Practice Location Address:
1810 NW 65TH 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:
98117-5531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-252-1727
Provider Business Practice Location Address Fax Number:
206-252-1721
Provider Enumeration Date:
09/13/2018