Provider First Line Business Practice Location Address:
600 N 36TH ST
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98103-8616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-271-4874
Provider Business Practice Location Address Fax Number:
866-227-5052
Provider Enumeration Date:
05/29/2007