Provider First Line Business Practice Location Address:
1747 NE 92ND 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:
98115-3253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-823-6119
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2026