Provider First Line Business Practice Location Address:
1129 29TH AVE S
Provider Second Line Business Practice Location Address:
APT 2
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98144-3117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-850-4387
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2007