Provider First Line Business Practice Location Address:
8747 PHINNEY AVE N
Provider Second Line Business Practice Location Address:
UNIT 1
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98103-3764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-270-8715
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2014