Provider First Line Business Practice Location Address:
1918 3RD AVE
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:
98101-1105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-623-1758
Provider Business Practice Location Address Fax Number:
206-623-1759
Provider Enumeration Date:
07/08/2006