Provider First Line Business Practice Location Address:
1617 5TH AVE N UNIT A
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:
98109-2934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-313-2117
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/24/2014