Provider First Line Business Practice Location Address:
5400 CALIFORNIA AVE SW
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98136-1501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-935-7407
Provider Business Practice Location Address Fax Number:
206-932-0401
Provider Enumeration Date:
06/16/2006