Provider First Line Business Practice Location Address:
7136 MARTIN LUTHER KING JR WAY S STE 201
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:
98118-3526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-353-4181
Provider Business Practice Location Address Fax Number:
206-708-6214
Provider Enumeration Date:
09/22/2025