Provider First Line Business Practice Location Address:
3516 FREMONT PL N STE E
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:
98103-8961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-859-9775
Provider Business Practice Location Address Fax Number:
360-783-7362
Provider Enumeration Date:
07/02/2026