Provider First Line Business Practice Location Address:
2717 DEXTER AVE N
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:
98109-1999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-372-0959
Provider Business Practice Location Address Fax Number:
206-501-4751
Provider Enumeration Date:
12/04/2019