Provider First Line Business Practice Location Address:
1203 E PINE 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:
98122-3921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-829-8432
Provider Business Practice Location Address Fax Number:
206-922-3294
Provider Enumeration Date:
08/29/2007