Provider First Line Business Practice Location Address:
5218 35TH AVENUE 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:
98118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-353-3781
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/21/2011