Provider First Line Business Practice Location Address:
1200 12TH AVE S
Provider Second Line Business Practice Location Address:
QUARTERS 6-7
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98144-2712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-621-4316
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2007