Provider First Line Business Practice Location Address:
1522 WESTERN AVE STE 24201
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:
98101-1522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-274-7448
Provider Business Practice Location Address Fax Number:
360-406-7956
Provider Enumeration Date:
01/30/2009