Provider First Line Business Practice Location Address:
11501 26TH AVE NE 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:
98125-5363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-778-6952
Provider Business Practice Location Address Fax Number:
206-778-6952
Provider Enumeration Date:
07/19/2006