Provider First Line Business Practice Location Address:
5701 6TH AVE S
Provider Second Line Business Practice Location Address:
SUITE 404
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98108-2568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-386-6602
Provider Business Practice Location Address Fax Number:
206-386-3720
Provider Enumeration Date:
09/19/2006