Provider First Line Business Practice Location Address:
1423 10TH AVE STE 9
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:
98122-3889
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-229-9822
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2025