Provider First Line Business Practice Location Address:
5960 1ST AVE SOUTH
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:
98108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-767-6660
Provider Business Practice Location Address Fax Number:
206-764-3398
Provider Enumeration Date:
05/25/2007