Provider First Line Business Practice Location Address:
4329 DENSMORE AVE N
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:
98103-7537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-634-3041
Provider Business Practice Location Address Fax Number:
360-443-7570
Provider Enumeration Date:
03/11/2025