Provider First Line Business Practice Location Address:
920 1ST AVE N
Provider Second Line Business Practice Location Address:
APT 316
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98109-5614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-987-1053
Provider Business Practice Location Address Fax Number:
206-987-3852
Provider Enumeration Date:
01/24/2007