Provider First Line Business Practice Location Address:
415 1ST AVE N
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:
98109-4503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
385-224-4199
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/13/2025