Provider First Line Business Practice Location Address:
1959 NE PACIFIC ST
Provider Second Line Business Practice Location Address:
ORAL AND MAXILLOFACIAL SURGERY CAMPUS BOX 357134
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98195-7134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-543-3097
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/30/2016