Provider First Line Business Practice Location Address:
520 NE 98TH 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:
98115-2139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-207-5842
Provider Business Practice Location Address Fax Number:
360-504-4330
Provider Enumeration Date:
09/05/2025