Provider First Line Business Practice Location Address:
4739 RAINIER AVE 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:
98118-1657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-721-1827
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2007