Provider First Line Business Practice Location Address:
1204 E COLUMBIA ST
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:
98122-4419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-329-3040
Provider Business Practice Location Address Fax Number:
206-329-3041
Provider Enumeration Date:
11/08/2006