Provider First Line Business Practice Location Address:
1815 N. 45TH STREET
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-547-1208
Provider Business Practice Location Address Fax Number:
206-547-8751
Provider Enumeration Date:
06/27/2007