Provider First Line Business Practice Location Address:
1812 NW 80TH 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:
98117-3646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-617-8162
Provider Business Practice Location Address Fax Number:
206-237-9066
Provider Enumeration Date:
07/20/2016