Provider First Line Business Practice Location Address:
1809 E JOHN ST UPPR
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:
98112-5234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-213-6383
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/15/2026