Provider First Line Business Practice Location Address:
353 W BERTONA 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:
98119-1503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-281-2657
Provider Business Practice Location Address Fax Number:
206-378-5030
Provider Enumeration Date:
09/18/2017