Provider First Line Business Practice Location Address:
2408 10TH AVE E APT A
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:
98102-4050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-380-9848
Provider Business Practice Location Address Fax Number:
206-325-9848
Provider Enumeration Date:
03/01/2007