Provider First Line Business Practice Location Address:
822 1ST AVE
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:
98104-1405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-624-1454
Provider Business Practice Location Address Fax Number:
206-624-6377
Provider Enumeration Date:
12/04/2006