Provider First Line Business Practice Location Address:
9639 28TH 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:
98126-4101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-935-6060
Provider Business Practice Location Address Fax Number:
206-932-7088
Provider Enumeration Date:
07/20/2016