Provider First Line Business Practice Location Address:
6022 CALIFORNIA AVE SW
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:
98136-1613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-573-2581
Provider Business Practice Location Address Fax Number:
646-601-6398
Provider Enumeration Date:
12/13/2006