Provider First Line Business Practice Location Address:
160 LEE ST
Provider Second Line Business Practice Location Address:
APT 307
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98109-3199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-245-6550
Provider Business Practice Location Address Fax Number:
888-972-2823
Provider Enumeration Date:
08/01/2006