Provider First Line Business Practice Location Address:
4431 MARTIN LUTHER KING JR WAY S
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:
98108-1606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-693-9605
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/23/2025