Provider First Line Business Practice Location Address:
1170 ALKI AVE SW APT 400
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:
98116-4829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-890-3340
Provider Business Practice Location Address Fax Number:
425-890-3340
Provider Enumeration Date:
07/01/2026