Provider First Line Business Practice Location Address:
2148 N 50TH 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:
98103-6943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-951-0213
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2025