Provider First Line Business Practice Location Address:
5100 S DAWSON ST
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98118-2100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-760-1448
Provider Business Practice Location Address Fax Number:
206-760-1730
Provider Enumeration Date:
04/21/2010