Provider First Line Business Practice Location Address:
1145 BROADWAY
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:
98122-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-860-4550
Provider Business Practice Location Address Fax Number:
206-624-9987
Provider Enumeration Date:
06/30/2009