Provider First Line Business Practice Location Address:
6511 23RD AVE NE
Provider Second Line Business Practice Location Address:
APT 2
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98115-6051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-755-7987
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/08/2008