Provider First Line Business Practice Location Address:
1959 N.E. PACIFIC HSC H-375P1
Provider Second Line Business Practice Location Address:
BOX 357630
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98195-7630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-616-4587
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/22/2005