Provider First Line Business Practice Location Address:
200 15TH AVE E
Provider Second Line Business Practice Location Address:
CHD-B19
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98112-5260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-326-3421
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2007