Provider First Line Business Practice Location Address:
1021 MERCER ST
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:
98109-4324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-489-2530
Provider Business Practice Location Address Fax Number:
206-489-2531
Provider Enumeration Date:
06/20/2005