Provider First Line Business Practice Location Address:
5901 ROOSEVELT WAY NE STE B
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:
98105-2763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-320-5510
Provider Business Practice Location Address Fax Number:
206-320-5522
Provider Enumeration Date:
12/19/2006