Provider First Line Business Practice Location Address:
1959 NE PACIFIC STREET
Provider Second Line Business Practice Location Address:
HSC B242 BOX 357136
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105-7136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-543-4885
Provider Business Practice Location Address Fax Number:
206-616-7470
Provider Enumeration Date:
09/20/2006