Provider First Line Business Practice Location Address:
119 SW 153RD
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:
98166-2311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-242-8485
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2007