Provider First Line Business Practice Location Address:
1201 E JOHN ST
Provider Second Line Business Practice Location Address:
#1
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98102-5836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-351-0995
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2007