Provider First Line Business Practice Location Address:
5410 CALIFORNIA AVE SW STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98136-1562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-331-3999
Provider Business Practice Location Address Fax Number:
206-388-3226
Provider Enumeration Date:
02/14/2007