Provider First Line Business Practice Location Address:
3213 EASTLAKE AVENUE EAST, SUITE A
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-861-8200
Provider Business Practice Location Address Fax Number:
206-324-1178
Provider Enumeration Date:
10/27/2006