Provider First Line Business Practice Location Address:
4616 MLK JR WAY S APT 316
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:
98108-2160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-371-2399
Provider Business Practice Location Address Fax Number:
206-397-3708
Provider Enumeration Date:
06/16/2022