Provider First Line Business Practice Location Address:
925 4TH AVE
Provider Second Line Business Practice Location Address:
STE 410
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98104-1157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-624-9912
Provider Business Practice Location Address Fax Number:
206-624-2520
Provider Enumeration Date:
12/22/2005