Provider First Line Business Practice Location Address:
12728 GREENWOOD AVE N
Provider Second Line Business Practice Location Address:
APT. 406
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-7996
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-225-7252
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2007