Provider First Line Business Practice Location Address:
1222 26TH AVE E
Provider Second Line Business Practice Location Address:
APT B
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98112-3631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-473-1426
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2012