Provider First Line Business Practice Location Address:
10640 16TH AVE SW
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:
98146-2076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-315-9937
Provider Business Practice Location Address Fax Number:
206-241-4975
Provider Enumeration Date:
07/28/2015