Provider First Line Business Practice Location Address:
1959 NE PACIFIC STREET; HSB ROOM B 241
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:
98195-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-849-6683
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2020