Provider First Line Business Practice Location Address:
3013 S MOUNT BAKER BLVD
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:
98144-6139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-252-6157
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/18/2014