Provider First Line Business Practice Location Address:
1535 NE 40TH STREET
Provider Second Line Business Practice Location Address:
GUTHRIE ANNEX 4, RM 101
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98195-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-543-2630
Provider Business Practice Location Address Fax Number:
206-616-1513
Provider Enumeration Date:
09/24/2007