Provider First Line Business Practice Location Address:
13344 1ST AVE NE STE 205
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:
98125-3059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-364-7575
Provider Business Practice Location Address Fax Number:
888-875-7123
Provider Enumeration Date:
04/03/2026