Provider First Line Business Practice Location Address:
2450 DEXTER AVE N APT 1
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:
98109-2223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-363-1921
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2009