Provider First Line Business Practice Location Address:
1329 N 47TH ST UNIT 31403
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:
98103-6866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-721-1969
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2007