Provider First Line Business Practice Location Address:
925 11TH AVENUE EAST1
Provider Second Line Business Practice Location Address:
#1
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-323-6890
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2006