Provider First Line Business Practice Location Address:
7716 MLK JR WAY S UNIT A
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:
98118-4043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-730-5822
Provider Business Practice Location Address Fax Number:
206-730-5822
Provider Enumeration Date:
04/07/2026