Provider First Line Business Practice Location Address:
5056 1/2 MLK JR WAY S
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:
98118-1913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-241-1668
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/18/2018