Provider First Line Business Practice Location Address:
423 30TH AVE
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:
98122-6232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-765-3548
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2026