Provider First Line Business Practice Location Address:
3714 S OREGON 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:
98118-1654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-570-2170
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2025