Provider First Line Business Practice Location Address:
3850 MONTLAKE BLVD NE RM 148 B
Provider Second Line Business Practice Location Address:
ARENA/HEC EDMUNDSON PAVILLION
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98195-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-543-1552
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2006