Provider First Line Business Practice Location Address:
13716 LAKE CITY WAY NE APT 309
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:
98125-2601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-378-4004
Provider Business Practice Location Address Fax Number:
360-378-2787
Provider Enumeration Date:
11/06/2007