Provider First Line Business Practice Location Address:
1728 SUMMIT AVE
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:
98122-2132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-492-0920
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2025