Provider First Line Business Practice Location Address:
2136 N 113TH ST UNIT B
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:
98133-8503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-556-5364
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2023