Provider First Line Business Practice Location Address:
4105 E MADISON ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98112-3291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-726-9595
Provider Business Practice Location Address Fax Number:
206-320-1468
Provider Enumeration Date:
11/28/2006