Provider First Line Business Practice Location Address:
325 9TH AVE BOX 359885
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:
98104-2499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-731-2894
Provider Business Practice Location Address Fax Number:
206-731-5997
Provider Enumeration Date:
04/09/2007