Provider First Line Business Practice Location Address:
12616 RENTON AVE S STE A
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:
98178-3711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-772-0163
Provider Business Practice Location Address Fax Number:
206-772-7822
Provider Enumeration Date:
08/21/2009