Provider First Line Business Practice Location Address:
417 E PINE ST
Provider Second Line Business Practice Location Address:
SUITE P
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98122-2395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-851-2242
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/31/2014