Provider First Line Business Practice Location Address:
5339 ROOSEVELT WAY NE STE A
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:
98105-3635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-605-8473
Provider Business Practice Location Address Fax Number:
206-590-8281
Provider Enumeration Date:
09/26/2019