Provider First Line Business Practice Location Address:
201 15TH AVE
Provider Second Line Business Practice Location Address:
CMB-5
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98122-5603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-326-2135
Provider Business Practice Location Address Fax Number:
206-326-2010
Provider Enumeration Date:
02/08/2006