Provider First Line Business Practice Location Address:
3917 SW PORTLAND ST
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:
98136-2156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-733-4343
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2012