Provider First Line Business Practice Location Address:
9240 INTERLAKE AVE N APT D
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:
98103-2805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-465-7620
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2013