Provider First Line Business Practice Location Address:
3936 S KENYON ST
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:
98118-4048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-302-2771
Provider Business Practice Location Address Fax Number:
206-302-2769
Provider Enumeration Date:
10/31/2016