Provider First Line Business Practice Location Address:
1145 BROADWAY
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:
98122-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-860-4522
Provider Business Practice Location Address Fax Number:
206-860-2292
Provider Enumeration Date:
09/12/2006