Provider First Line Business Practice Location Address:
103 13TH AVE E
Provider Second Line Business Practice Location Address:
APT #27
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98102-5856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-212-8111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2012