Provider First Line Business Practice Location Address:
5919 SHAFFER 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:
98108-3139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-658-0187
Provider Business Practice Location Address Fax Number:
206-725-4735
Provider Enumeration Date:
03/10/2009