Provider First Line Business Practice Location Address:
9111 ROOSEVELT WAY NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98115-2839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-525-8078
Provider Business Practice Location Address Fax Number:
206-525-1913
Provider Enumeration Date:
10/01/2006