Provider First Line Business Practice Location Address:
515 MINOR AVE STE 16
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:
98104-2112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-622-0246
Provider Business Practice Location Address Fax Number:
206-624-0766
Provider Enumeration Date:
11/08/2006