Provider First Line Business Practice Location Address:
3916 S PEARL 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:
98118-1956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-329-0252
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2026