Provider First Line Business Practice Location Address:
7917 MARTIN LUTHER KING JR WAY S APT 1
Provider Second Line Business Practice Location Address:
APT 1
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98118-4339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-939-9753
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2025