Provider First Line Business Practice Location Address:
325 NINTH AVE, BOX 359728
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:
98104-2499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-731-3561
Provider Business Practice Location Address Fax Number:
206-731-8560
Provider Enumeration Date:
09/20/2006