Provider First Line Business Practice Location Address:
2200 RAINIER 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:
98144-4642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-417-9904
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2026