Provider First Line Business Practice Location Address:
9500 ROOSEVELT WAY N.E.
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98115-2253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-523-1677
Provider Business Practice Location Address Fax Number:
206-517-8113
Provider Enumeration Date:
05/08/2007