Provider First Line Business Practice Location Address:
1618 S LANE 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:
98144-2829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-393-6064
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2023