Provider First Line Business Practice Location Address:
718 N 143RD ST APT 308
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-6969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-362-2738
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2011