Provider First Line Business Practice Location Address:
4708 S MEAD 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:
98118-2810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-474-6267
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/22/2022