Provider First Line Business Practice Location Address:
2450 DEXTER AVE N APT 304
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:
98109-2246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-285-8477
Provider Business Practice Location Address Fax Number:
206-285-8477
Provider Enumeration Date:
03/07/2008