Provider First Line Business Practice Location Address:
6726 SHAFFER AVE S
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:
98108-3781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-407-4324
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2025