Provider First Line Business Practice Location Address:
7913 MLK JR WAY S APT 3
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:
98118-4361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-785-5995
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2026