Provider First Line Business Practice Location Address:
1959 NE PACIFIC ST BOX 356165
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:
98195-5788
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-598-7226
Provider Business Practice Location Address Fax Number:
206-598-2475
Provider Enumeration Date:
12/07/2006