Provider First Line Business Practice Location Address:
1116 SUMMIT AVE
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:
98101-2831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-323-0930
Provider Business Practice Location Address Fax Number:
206-323-0933
Provider Enumeration Date:
03/07/2017