Provider First Line Business Practice Location Address:
4634 E. MARGINAL WAY S.
Provider Second Line Business Practice Location Address:
#C-120
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-932-7943
Provider Business Practice Location Address Fax Number:
206-932-8686
Provider Enumeration Date:
02/16/2009