Provider First Line Business Practice Location Address:
4649 SUNNYSIDE AVE N STE 343
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:
98103-6955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-215-0534
Provider Business Practice Location Address Fax Number:
206-524-6530
Provider Enumeration Date:
03/20/2007