Provider First Line Business Practice Location Address:
1415 S CLOVERDALE 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:
98108-4826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-762-2337
Provider Business Practice Location Address Fax Number:
206-762-0344
Provider Enumeration Date:
04/30/2013