Provider First Line Business Practice Location Address:
1800 WESTLAKE AVE NORTH
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-733-7186
Provider Business Practice Location Address Fax Number:
208-733-7178
Provider Enumeration Date:
07/24/2006