Provider First Line Business Practice Location Address:
2212 S JACKSON 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:
98144-2591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-324-6999
Provider Business Practice Location Address Fax Number:
206-322-6306
Provider Enumeration Date:
11/29/2022