Provider First Line Business Practice Location Address:
2217 NW MARKET ST
Provider Second Line Business Practice Location Address:
SUITE 26
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98107-4062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-789-6964
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2007