Provider First Line Business Practice Location Address:
1203 JAMES ST
Provider Second Line Business Practice Location Address:
APARTMENT #102
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98104-2129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-240-2614
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2011