Provider First Line Business Practice Location Address:
1124 S DAWSON 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:
98108-2326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-375-8666
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2019