Provider First Line Business Practice Location Address:
2230 NW 59TH ST 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:
98107-3145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-979-0639
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2026