Provider First Line Business Practice Location Address:
1120 CHERRY ST
Provider Second Line Business Practice Location Address:
240
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98104-2044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-624-0296
Provider Business Practice Location Address Fax Number:
206-624-1399
Provider Enumeration Date:
06/25/2009