Provider First Line Business Practice Location Address:
1128 NE 41ST ST
Provider Second Line Business Practice Location Address:
CEDAR APARTMENTS E305
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105-6373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-647-0356
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2016