Provider First Line Business Practice Location Address:
1628 FIFTH AVE
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:
98101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-622-0582
Provider Business Practice Location Address Fax Number:
206-343-2328
Provider Enumeration Date:
08/24/2006