Provider First Line Business Practice Location Address:
3009 3RD AVE W APT 3
Provider Second Line Business Practice Location Address:
UNIT 3
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98119-1926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-271-4596
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2012