Provider First Line Business Practice Location Address:
2600 SW BARTON STREET
Provider Second Line Business Practice Location Address:
SUITE A24
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-453-5397
Provider Business Practice Location Address Fax Number:
206-453-5630
Provider Enumeration Date:
11/24/2006