Provider First Line Business Practice Location Address:
128 24TH AVE E 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:
98112-4772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-745-4712
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2020