Provider First Line Business Practice Location Address:
1959 NE PACIFIC STREET
Provider Second Line Business Practice Location Address:
NW011; MAILING ADDRESS: BOX 357233
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98195-2908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-598-5130
Provider Business Practice Location Address Fax Number:
206-598-8475
Provider Enumeration Date:
04/15/2020