Provider First Line Business Practice Location Address:
4555 CALIFORNIA AVE SW
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:
98116-4110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-932-8276
Provider Business Practice Location Address Fax Number:
206-937-2849
Provider Enumeration Date:
11/02/2006