Provider First Line Business Practice Location Address:
4245 ROOSEVELT WAY NE
Provider Second Line Business Practice Location Address:
BOX 354740
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-598-0395
Provider Business Practice Location Address Fax Number:
206-598-4015
Provider Enumeration Date:
03/29/2007