Provider First Line Business Practice Location Address:
140 4TH AVE N
Provider Second Line Business Practice Location Address:
STE 170
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98109-4940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-404-9700
Provider Business Practice Location Address Fax Number:
206-404-9705
Provider Enumeration Date:
10/22/2009