Provider First Line Business Practice Location Address:
3811 S FERDINAND ST
Provider Second Line Business Practice Location Address:
APT B
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98118-1759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-760-6064
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/18/2014