Provider First Line Business Practice Location Address:
101 14TH 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:
98112-5207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-323-7880
Provider Business Practice Location Address Fax Number:
206-323-5868
Provider Enumeration Date:
06/26/2006