Provider First Line Business Practice Location Address:
1904 3RD AVENUE
Provider Second Line Business Practice Location Address:
STE 826
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98101-1123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-713-6130
Provider Business Practice Location Address Fax Number:
206-686-5058
Provider Enumeration Date:
01/23/2006