Provider First Line Business Practice Location Address:
12349 ROOSEVELT WAY NE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-4852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-365-3808
Provider Business Practice Location Address Fax Number:
206-367-4115
Provider Enumeration Date:
01/04/2007