Provider First Line Business Practice Location Address:
2208 NW MARKET ST
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:
98107-4030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-306-9391
Provider Business Practice Location Address Fax Number:
888-924-0687
Provider Enumeration Date:
10/17/2011