Provider First Line Business Practice Location Address:
503 12 AVE 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-288-9911
Provider Business Practice Location Address Fax Number:
206-720-4004
Provider Enumeration Date:
08/31/2006