Provider First Line Business Practice Location Address:
411 12TH AVE STE 301
Provider Second Line Business Practice Location Address:
BOX 359920
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98122-5523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-521-1675
Provider Business Practice Location Address Fax Number:
206-521-1682
Provider Enumeration Date:
04/07/2006