Provider First Line Business Practice Location Address:
1200 12TH AVE S
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:
98144-2712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-621-4109
Provider Business Practice Location Address Fax Number:
206-531-2394
Provider Enumeration Date:
09/26/2006