Provider First Line Business Practice Location Address:
1414 E HOWELL ST
Provider Second Line Business Practice Location Address:
APT 2
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98122-2640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-650-3205
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2009