Provider First Line Business Practice Location Address:
6108 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:
98115-6613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-524-4977
Provider Business Practice Location Address Fax Number:
206-524-4340
Provider Enumeration Date:
01/02/2012