Provider First Line Business Practice Location Address:
2200 6TH AVE.
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-388-3515
Provider Business Practice Location Address Fax Number:
206-259-2725
Provider Enumeration Date:
09/30/2026