Provider First Line Business Practice Location Address:
2034 MINOR AVE E APT 102
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:
98102-3533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-969-2324
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2021