Provider First Line Business Practice Location Address:
861 POPLAR PL S
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:
98144-2827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-568-4440
Provider Business Practice Location Address Fax Number:
206-720-4403
Provider Enumeration Date:
09/28/2006