Provider First Line Business Practice Location Address:
605 5TH AVE S
Provider Second Line Business Practice Location Address:
#150
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98104-3886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-462-4859
Provider Business Practice Location Address Fax Number:
206-223-7926
Provider Enumeration Date:
10/30/2007