Provider First Line Business Practice Location Address:
5655 48TH 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:
98136-1301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-641-0113
Provider Business Practice Location Address Fax Number:
206-539-2871
Provider Enumeration Date:
01/11/2017