Provider First Line Business Practice Location Address:
12558 22ND AVE NE
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:
98125-4202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-565-4011
Provider Business Practice Location Address Fax Number:
206-440-1800
Provider Enumeration Date:
10/21/2026