Provider First Line Business Practice Location Address:
2601 BROADWAY E
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:
98102-3906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-323-7131
Provider Business Practice Location Address Fax Number:
206-322-4078
Provider Enumeration Date:
04/15/2009