Provider First Line Business Practice Location Address:
1628 N 45TH 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:
98103-6702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-632-5850
Provider Business Practice Location Address Fax Number:
206-632-3638
Provider Enumeration Date:
03/25/2026