Provider First Line Business Practice Location Address:
417 BROADWAY E
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:
98102-5009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-328-6960
Provider Business Practice Location Address Fax Number:
206-328-6560
Provider Enumeration Date:
07/13/2006