Provider First Line Business Practice Location Address:
5811 RAINIER AVE S STE 111
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:
98118-2705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-383-5539
Provider Business Practice Location Address Fax Number:
206-260-2741
Provider Enumeration Date:
11/24/2025