Provider First Line Business Practice Location Address:
3712 S FERDINAND ST
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:
98118-1736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-516-1745
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2026