Provider First Line Business Practice Location Address:
12745 19TH AVE NE
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:
98125-4110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-501-9992
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2026