Provider First Line Business Practice Location Address:
12317 10TH PL NE
Provider Second Line Business Practice Location Address:
APT C
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-4832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-315-2196
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2015