Provider First Line Business Practice Location Address:
2120 S PLUM ST STE C
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:
98144-4539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-838-4567
Provider Business Practice Location Address Fax Number:
206-838-4598
Provider Enumeration Date:
10/18/2021