Provider First Line Business Practice Location Address:
9650 15TH AVE SW
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:
98106-2576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-965-1055
Provider Business Practice Location Address Fax Number:
206-965-1032
Provider Enumeration Date:
03/31/2017