Provider First Line Business Practice Location Address:
3912 SW 100TH ST
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:
98146-3635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-947-7886
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/04/2012