Provider First Line Business Practice Location Address:
662 S JACKSON ST
Provider Second Line Business Practice Location Address:
UNIT A
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98104-2929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-623-0733
Provider Business Practice Location Address Fax Number:
206-623-1014
Provider Enumeration Date:
12/13/2007