Provider First Line Business Practice Location Address:
2003 WESTERN AVE.
Provider Second Line Business Practice Location Address:
SUITE 340
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98121-2213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-443-9810
Provider Business Practice Location Address Fax Number:
206-448-4899
Provider Enumeration Date:
10/02/2006