Provider First Line Business Practice Location Address:
100 W HARRISON ST
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98119-4116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-352-0105
Provider Business Practice Location Address Fax Number:
206-352-0106
Provider Enumeration Date:
06/16/2009