Provider First Line Business Practice Location Address:
4649 SUNNYSIDE AVE N
Provider Second Line Business Practice Location Address:
SUITE 300
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:
206-634-2162
Provider Business Practice Location Address Fax Number:
206-417-2841
Provider Enumeration Date:
08/16/2006