Provider First Line Business Practice Location Address:
224 1/2 MINOR AVE N
Provider Second Line Business Practice Location Address:
APT C
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98109-5405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-349-1355
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2010