Provider First Line Business Practice Location Address:
4409 50TH AVE S
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:
98118-1427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-451-7037
Provider Business Practice Location Address Fax Number:
206-402-6104
Provider Enumeration Date:
04/13/2016