Provider First Line Business Practice Location Address:
12304 28 AVE S AP H2
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:
98168-2415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-280-8196
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2025