Provider First Line Business Practice Location Address:
4508 S ORCAS 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:
98118-2431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-725-9908
Provider Business Practice Location Address Fax Number:
206-760-8013
Provider Enumeration Date:
01/29/2014