Provider First Line Business Practice Location Address:
4649 SUNNYSIDE AVE N
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98103-6900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-547-2996
Provider Business Practice Location Address Fax Number:
206-547-5187
Provider Enumeration Date:
11/14/2011