Provider First Line Business Practice Location Address:
2107 16TH 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:
98144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-450-2719
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2016