Provider First Line Business Practice Location Address:
4208 SW OREGON 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:
98116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-938-3175
Provider Business Practice Location Address Fax Number:
206-938-1848
Provider Enumeration Date:
01/24/2007