Provider First Line Business Practice Location Address:
2150 N 107TH ST STE 204
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:
98133-9009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-957-7772
Provider Business Practice Location Address Fax Number:
206-957-6021
Provider Enumeration Date:
02/06/2026