Provider First Line Business Practice Location Address:
1719 NW MARKET ST
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:
98107-5225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-784-2090
Provider Business Practice Location Address Fax Number:
206-784-8939
Provider Enumeration Date:
04/12/2007