Provider First Line Business Practice Location Address:
10102 8TH AVE S APT D27
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:
98168-5522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-638-3548
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2026