Provider First Line Business Practice Location Address:
7101 MLK JR WAY S
Provider Second Line Business Practice Location Address:
SUITE # 217
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98118-3594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-722-7786
Provider Business Practice Location Address Fax Number:
206-722-7884
Provider Enumeration Date:
03/27/2010