Provider First Line Business Practice Location Address:
2056 13TH AVE W APT B
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:
98119-2750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-281-2824
Provider Business Practice Location Address Fax Number:
206-378-5030
Provider Enumeration Date:
05/15/2007