Provider First Line Business Practice Location Address:
8646 45TH AVE S
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:
98118-4904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-371-4822
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2026