Provider First Line Business Practice Location Address:
5031 MARTIN LUTHER KING JR WAY S
Provider Second Line Business Practice Location Address:
# 18
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98118-1963
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-721-9129
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2005