Provider First Line Business Practice Location Address:
1507 S HILL ST
Provider Second Line Business Practice Location Address:
UPPR
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98144-4268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-448-8574
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2016