Provider First Line Business Practice Location Address:
3225 BENTON PL SW APT 205
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:
98116-2659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-981-5268
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2010