Provider First Line Business Practice Location Address:
5470 SHILSHOLE AVE NW
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:
98107-4040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-559-2887
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/07/2025