Provider First Line Business Practice Location Address:
819 N 49TH ST
Provider Second Line Business Practice Location Address:
DEPT 101, BOX 1A
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98103-6576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-880-3952
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/19/2024