Provider First Line Business Practice Location Address:
5608 17TH AVE NW STE 2096
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:
98107-5232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-341-2054
Provider Business Practice Location Address Fax Number:
206-208-4860
Provider Enumeration Date:
04/11/2026