Provider First Line Business Practice Location Address:
819 23RD AVE E APT 2
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:
98112-4159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-705-0352
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2019