Provider First Line Business Practice Location Address:
1138 POPLAR PLACE SOUTH
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:
98144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-733-5615
Provider Business Practice Location Address Fax Number:
832-485-0696
Provider Enumeration Date:
04/13/2023