Provider First Line Business Practice Location Address:
311 TERRY AVE N
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:
98109-5222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-279-2870
Provider Business Practice Location Address Fax Number:
206-279-2872
Provider Enumeration Date:
10/31/2026