Provider First Line Business Practice Location Address:
2628 W PLYMOUTH 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:
98199-4125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-334-6650
Provider Business Practice Location Address Fax Number:
425-954-7552
Provider Enumeration Date:
01/29/2026