Provider First Line Business Practice Location Address:
120 LAKESIDE AVE STE 230
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:
98122-6552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-855-3698
Provider Business Practice Location Address Fax Number:
206-800-3708
Provider Enumeration Date:
07/30/2026