Provider First Line Business Practice Location Address:
4649 SUNNYSIDE AVE N
Provider Second Line Business Practice Location Address:
SUITE#301
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:
206-525-9035
Provider Business Practice Location Address Fax Number:
206-525-4838
Provider Enumeration Date:
02/25/2009