Provider First Line Business Practice Location Address:
526 W MERCER PL APT 203
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:
98119-3836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-748-9191
Provider Business Practice Location Address Fax Number:
206-748-9191
Provider Enumeration Date:
03/29/2007