Provider First Line Business Practice Location Address:
5410 CALIFORNIA AVE SW
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98136-1562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-935-1111
Provider Business Practice Location Address Fax Number:
206-935-1128
Provider Enumeration Date:
12/12/2006