Provider First Line Business Practice Location Address:
649 MEDICAL DENTAL BLDG., 509 OLIVE WAY
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:
98101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-682-2420
Provider Business Practice Location Address Fax Number:
206-682-1060
Provider Enumeration Date:
05/18/2007