Provider First Line Business Practice Location Address:
415 10TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98122-7439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-223-1533
Provider Business Practice Location Address Fax Number:
206-223-1535
Provider Enumeration Date:
11/20/2006