Provider First Line Business Practice Location Address:
601 S WASHINGTON ST APT 314
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:
98104-3701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-948-2478
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2026