Provider First Line Business Practice Location Address:
7947 17TH AVE SW
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:
98106-1855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-207-8372
Provider Business Practice Location Address Fax Number:
206-803-2489
Provider Enumeration Date:
04/01/2026