Provider First Line Business Practice Location Address:
12028 28TH AVE NE UNIT B
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:
98125-5314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-506-8222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2026