Provider First Line Business Practice Location Address:
610 1ST AVENUE NORTH
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:
98109-4001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-569-4443
Provider Business Practice Location Address Fax Number:
206-973-3032
Provider Enumeration Date:
10/18/2010