Provider First Line Business Practice Location Address:
1107 E REPUBLICAN ST APT C
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:
98102-5133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-286-2322
Provider Business Practice Location Address Fax Number:
206-286-2301
Provider Enumeration Date:
02/22/2007