Provider First Line Business Practice Location Address:
1220 NE 143RD ST APT 215G
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:
98125-3151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-631-1040
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2020