Provider First Line Business Practice Location Address:
3248 LAKEWOOD 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:
98144-7230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-979-1120
Provider Business Practice Location Address Fax Number:
206-215-2555
Provider Enumeration Date:
10/04/2006