Provider First Line Business Practice Location Address:
8447 GRATTAN PL 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:
98118-4723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-294-9915
Provider Business Practice Location Address Fax Number:
206-582-1067
Provider Enumeration Date:
07/23/2025