Provider First Line Business Practice Location Address:
7418 28TH AVE NW
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:
98117-5951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-393-5114
Provider Business Practice Location Address Fax Number:
360-733-1928
Provider Enumeration Date:
08/20/2026