Provider First Line Business Practice Location Address:
7659 LATONA AVE NE UNIT B
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:
98115-4047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-492-4782
Provider Business Practice Location Address Fax Number:
206-238-9797
Provider Enumeration Date:
12/05/2022