Provider First Line Business Practice Location Address:
8344 28TH AVE NW APT 1
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:
98117-4519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-474-8931
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2026