Provider First Line Business Practice Location Address:
2211 E. MADISON ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-788-4488
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2012