Provider First Line Business Practice Location Address:
6919 S 120TH PL
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:
98178-4138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-270-4992
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/07/2026