Provider First Line Business Practice Location Address:
411 12TH AVE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98122-5577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-368-6876
Provider Business Practice Location Address Fax Number:
206-368-9000
Provider Enumeration Date:
06/22/2006