Provider First Line Business Practice Location Address:
4649 SUNNYSIDE AVENUE N
Provider Second Line Business Practice Location Address:
STE 341
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:
206-329-9235
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/14/2006