Provider First Line Business Practice Location Address:
8008 S 114TH 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:
98178-3242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-383-4516
Provider Business Practice Location Address Fax Number:
206-826-1397
Provider Enumeration Date:
08/05/2020