Provider First Line Business Practice Location Address:
6901 MARTIN LUTHER KING JR WAY S APT 711
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:
98118-2296
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-472-8156
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/23/2026