Provider First Line Business Practice Location Address:
1752 NW MARKET ST
Provider Second Line Business Practice Location Address:
415
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-762-4823
Provider Business Practice Location Address Fax Number:
206-458-6007
Provider Enumeration Date:
10/23/2019