Provider First Line Business Practice Location Address:
6044 MLK JR WAY S
Provider Second Line Business Practice Location Address:
STE #101
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-760-9571
Provider Business Practice Location Address Fax Number:
206-760-9627
Provider Enumeration Date:
04/08/2010