Provider First Line Business Practice Location Address:
1959 NE PACIFIC ST
Provider Second Line Business Practice Location Address:
C-212, BOX 356340
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98195-6340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-543-0065
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2006