Provider First Line Business Practice Location Address:
8531 LAKE CITY WAY 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:
98115-3258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-608-1852
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2026