Provider First Line Business Practice Location Address:
1706 N 50TH ST 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:
98103-6826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-380-8321
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2006