Provider First Line Business Practice Location Address:
201 16TH AVE E
Provider Second Line Business Practice Location Address:
MS: CWB-2
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98112-5226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-324-1449
Provider Business Practice Location Address Fax Number:
206-324-6977
Provider Enumeration Date:
08/30/2006