Provider First Line Business Practice Location Address:
1420 TERRY AVE UNIT 608
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:
98101-1982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-641-4935
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2025