Provider First Line Business Practice Location Address:
9635 DES MOINES MEM DR S STE 210
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:
98108-5061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-658-2175
Provider Business Practice Location Address Fax Number:
206-658-2170
Provider Enumeration Date:
09/12/2019