Provider First Line Business Practice Location Address:
812 5TH AVE N
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98109-6123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-284-0566
Provider Business Practice Location Address Fax Number:
206-284-0573
Provider Enumeration Date:
04/03/2007