Provider First Line Business Practice Location Address:
620 S JACKSON 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:
98104-2911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-624-4238
Provider Business Practice Location Address Fax Number:
206-682-2089
Provider Enumeration Date:
12/08/2006