Provider First Line Business Practice Location Address:
626 SO. JACKSON 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:
98104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-652-0696
Provider Business Practice Location Address Fax Number:
206-760-5710
Provider Enumeration Date:
02/28/2007