Provider First Line Business Practice Location Address:
2349 YALE AVE E APT 5
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:
98102-3336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-286-9170
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2022