Provider First Line Business Practice Location Address:
7101 ML KING JR WAY S
Provider Second Line Business Practice Location Address:
STE 101B
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98118-3594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-721-5009
Provider Business Practice Location Address Fax Number:
206-721-3931
Provider Enumeration Date:
08/31/2006