Provider First Line Business Practice Location Address:
13143 83RD LN 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:
98178-4953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-422-3437
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2026