Provider First Line Business Practice Location Address:
1221 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98144-2089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-328-6156
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2006