Provider First Line Business Practice Location Address:
7946 9TH AVE SW UNIT B
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:
98106-2156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-283-0452
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2012