Provider First Line Business Practice Location Address:
13028 S INTERURBAN AVE
Provider Second Line Business Practice Location Address:
#106
Provider Business Practice Location Address City Name:
TUKWILA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98168-3340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-957-7950
Provider Business Practice Location Address Fax Number:
206-957-7952
Provider Enumeration Date:
01/05/2007