Provider First Line Business Practice Location Address:
1000 8TH AVE APT 1-908
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:
98104-1169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-590-6816
Provider Business Practice Location Address Fax Number:
402-590-6816
Provider Enumeration Date:
04/03/2008