Provider First Line Business Practice Location Address:
422 YALE AVE N
Provider Second Line Business Practice Location Address:
APT 203
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98109-5449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-913-9613
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/21/2010