Provider First Line Business Practice Location Address:
419 NE 71ST ST STE A
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:
98115-5873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-288-0052
Provider Business Practice Location Address Fax Number:
206-524-0952
Provider Enumeration Date:
02/21/2025