Provider First Line Business Practice Location Address:
4203 RAINIER AVE S
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98118-1390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-721-2349
Provider Business Practice Location Address Fax Number:
206-723-4321
Provider Enumeration Date:
11/14/2010