Provider First Line Business Practice Location Address:
1100 9TH AVENUE
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-583-6504
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2007