Provider First Line Business Practice Location Address:
5224 WILSON AVE S
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98118-2587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-218-9527
Provider Business Practice Location Address Fax Number:
888-217-6433
Provider Enumeration Date:
01/03/2013