Provider First Line Business Practice Location Address:
527 30TH AVE S APT 1
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:
98144-2560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-437-6654
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2006