Provider First Line Business Practice Location Address:
1227 N ALLEN PL
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:
98103-7412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-624-6627
Provider Business Practice Location Address Fax Number:
206-525-5933
Provider Enumeration Date:
10/19/2019