Provider First Line Business Practice Location Address:
519 MINOR AVE N
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98109-5517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-386-9500
Provider Business Practice Location Address Fax Number:
206-386-9605
Provider Enumeration Date:
09/30/2005