Provider First Line Business Practice Location Address:
4225 ROOSEVELT WAY NE
Provider Second Line Business Practice Location Address:
CAMPUS BOX 354691
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105-6099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-598-4882
Provider Business Practice Location Address Fax Number:
206-598-4976
Provider Enumeration Date:
09/15/2006