Provider First Line Business Practice Location Address:
4155 14TH 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:
98108-1433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-761-0170
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2019