Provider First Line Business Practice Location Address:
2124 FOURTH AVENUE
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:
98121-2311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-296-4960
Provider Business Practice Location Address Fax Number:
206-296-0184
Provider Enumeration Date:
11/24/2006