Provider First Line Business Practice Location Address:
1519 3RD AVE
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98101-1630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-602-6544
Provider Business Practice Location Address Fax Number:
206-602-6545
Provider Enumeration Date:
10/20/2006