Provider First Line Business Practice Location Address:
1200 S JACKSON STREET
Provider Second Line Business Practice Location Address:
SUITE 22
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-328-9426
Provider Business Practice Location Address Fax Number:
206-328-9735
Provider Enumeration Date:
09/20/2007