Provider First Line Business Practice Location Address:
6553 CALIFORNIA AVE SW
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-383-6085
Provider Business Practice Location Address Fax Number:
636-246-6933
Provider Enumeration Date:
02/22/2022