Provider First Line Business Practice Location Address:
2435 7TH AVE W 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:
98119-2550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-739-1841
Provider Business Practice Location Address Fax Number:
310-398-0546
Provider Enumeration Date:
03/13/2007