Provider First Line Business Practice Location Address:
5135 S BANGOR 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:
98178-2108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-970-5960
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2024