Provider First Line Business Practice Location Address:
3215 NE 143RD ST APT B607
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:
98125-3789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-593-5835
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2026