Provider First Line Business Practice Location Address:
5400 CALIFORNIA AVE SW
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98136-1501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-391-5479
Provider Business Practice Location Address Fax Number:
206-641-9702
Provider Enumeration Date:
07/16/2012