Provider First Line Business Practice Location Address:
6247 3RD AVE NW
Provider Second Line Business Practice Location Address:
APT. 1
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98107-2159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-227-1980
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2013