Provider First Line Business Practice Location Address:
229 BROADWAY E
Provider Second Line Business Practice Location Address:
SUITE 20
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98102-5787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-551-2593
Provider Business Practice Location Address Fax Number:
206-326-1085
Provider Enumeration Date:
02/15/2011