Provider First Line Business Practice Location Address:
1239 NE 91ST 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:
98115-3132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-535-4500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2026