Provider First Line Business Practice Location Address:
10001 17TH PL S
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98168-1615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-766-6976
Provider Business Practice Location Address Fax Number:
206-766-6993
Provider Enumeration Date:
04/24/2012