Provider First Line Business Practice Location Address:
503 N 50TH 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:
98103-6033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-603-2095
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2025