Provider First Line Business Practice Location Address:
3832 S EDMUNDS 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:
98118-1730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-913-7039
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/26/2022