Provider First Line Business Practice Location Address:
1959 NE PACIFIC ST RM D458
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:
98195-1540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-543-5919
Provider Business Practice Location Address Fax Number:
206-543-7783
Provider Enumeration Date:
09/30/2005