Provider First Line Business Practice Location Address:
515 MINOR AVE STE 240
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:
98104-2133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-420-3119
Provider Business Practice Location Address Fax Number:
206-453-5912
Provider Enumeration Date:
02/21/2012