Provider First Line Business Practice Location Address:
325 NINTH AVENUE
Provider Second Line Business Practice Location Address:
BOX 359702
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-539-4850
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2026