Provider First Line Business Practice Location Address:
1605 S WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98144-2132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-322-2345
Provider Business Practice Location Address Fax Number:
206-322-2347
Provider Enumeration Date:
04/25/2007