Provider First Line Business Practice Location Address:
4519 CALIFORNIA AVE SW
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:
98116-4110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-938-3711
Provider Business Practice Location Address Fax Number:
206-938-0542
Provider Enumeration Date:
02/03/2021