Provider First Line Business Practice Location Address:
1959 NE PACIFIC ST
Provider Second Line Business Practice Location Address:
RM AA522, BOX 356422
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98195-6422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-685-1397
Provider Business Practice Location Address Fax Number:
206-616-4847
Provider Enumeration Date:
11/26/2007