Provider First Line Business Practice Location Address:
6523 21ST AVE NE APT 3
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:
98115-6924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-852-5367
Provider Business Practice Location Address Fax Number:
206-729-8803
Provider Enumeration Date:
03/16/2007