Provider First Line Business Practice Location Address:
1040 S HENDERSON ST
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:
98108-4720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-764-4717
Provider Business Practice Location Address Fax Number:
206-763-5225
Provider Enumeration Date:
01/29/2008