Provider First Line Business Practice Location Address:
7915 MARTIN LUTHER KING JR WAY S APT 1
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:
98118-4362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-428-8836
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2026