Provider First Line Business Practice Location Address:
3032 NE 85TH ST
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:
98115-3521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-778-7048
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2026