Provider First Line Business Practice Location Address:
2562 THORNDYKE AVE W APT 406
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:
98199-3542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-427-6133
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2026