Provider First Line Business Practice Location Address:
1202 E PINE 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:
98122-3929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-705-3035
Provider Business Practice Location Address Fax Number:
206-374-2570
Provider Enumeration Date:
05/08/2026