Provider First Line Business Practice Location Address:
4424 PHINNEY 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:
98103-7104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-353-9180
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2026