Provider First Line Business Practice Location Address:
5802 RAINIER 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:
98118-2706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-723-1980
Provider Business Practice Location Address Fax Number:
206-721-3930
Provider Enumeration Date:
04/04/2012