Provider First Line Business Practice Location Address:
4141 CALIFORNIA AVE SW
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:
98116-4101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-938-1393
Provider Business Practice Location Address Fax Number:
206-938-5849
Provider Enumeration Date:
10/01/2006