Provider First Line Business Practice Location Address:
5047 49TH AVE SW
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:
98136-1010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-999-9623
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/09/2026