Provider First Line Business Practice Location Address: 
3800 LINDEN AVE N APT 5
    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: 
98103-8727
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
206-569-5570
    Provider Business Practice Location Address Fax Number: 
206-567-9798
    Provider Enumeration Date: 
04/12/2022