Provider First Line Business Practice Location Address:
4225 ROOSEVELT WAY NE
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98195-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-598-7792
Provider Business Practice Location Address Fax Number:
206-598-7794
Provider Enumeration Date:
07/04/2007