Provider First Line Business Practice Location Address:
212 ALASKAN WAY S
Provider Second Line Business Practice Location Address:
SUITE 105A
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-618-5114
Provider Business Practice Location Address Fax Number:
206-577-3803
Provider Enumeration Date:
12/22/2006