Provider First Line Business Practice Location Address:
1550 NORTH 115TH STREET BOX 358828
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:
98133-9733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-589-2091
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2025