Provider First Line Business Practice Location Address:
4101 W MARGINAL WAY SW STE B4
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:
98106-1284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-763-8228
Provider Business Practice Location Address Fax Number:
206-763-8220
Provider Enumeration Date:
10/03/2006