Provider First Line Business Practice Location Address:
740 NE 56TH ST
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:
98105-2727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-410-7243
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2023