Provider First Line Business Practice Location Address:
3927 S LUCILE ST
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:
98118-2257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-483-6054
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2023