Provider First Line Business Practice Location Address:
4533 41ST AVE SW APT 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:
98116-4263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-890-4858
Provider Business Practice Location Address Fax Number:
206-890-4858
Provider Enumeration Date:
11/23/2008