Provider First Line Business Practice Location Address:
6600 RAINIER AVE S APT 8
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:
98118-3364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-792-6722
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2025