Provider First Line Business Practice Location Address:
941 24TH AVE S APT B
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:
98144-3052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-930-9041
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2025