Provider First Line Business Practice Location Address:
1211 NORTH 41ST STREET
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:
98103-8009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-547-1991
Provider Business Practice Location Address Fax Number:
206-547-0149
Provider Enumeration Date:
02/05/2007