Provider First Line Business Practice Location Address:
126 NW CANAL ST
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98107-4970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-774-0532
Provider Business Practice Location Address Fax Number:
206-407-3118
Provider Enumeration Date:
11/10/2006