Provider First Line Business Practice Location Address:
5601 S AUGUSTA ST
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:
98178-2810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-331-5815
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2009