Provider First Line Business Practice Location Address:
611 12TH AVE S STE 200
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:
98144-1911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-324-9360
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2006