Provider First Line Business Practice Location Address:
4517 CALIFORNIA AVE SW STE H
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:
98116-4903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-243-7848
Provider Business Practice Location Address Fax Number:
206-629-7676
Provider Enumeration Date:
01/31/2012