Provider First Line Business Practice Location Address:
5737 S PRENTICE 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:
98178-2248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-690-8150
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2018