Provider First Line Business Practice Location Address:
3333 WALLINGFORD AVE N STE C4
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:
98103-9001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-634-2022
Provider Business Practice Location Address Fax Number:
206-634-9460
Provider Enumeration Date:
03/17/2026