Provider First Line Business Practice Location Address: 
6100 SOUTHCENTER BLVD
    Provider Second Line Business Practice Location Address: 
SOUND MENTAL HEALTH
    Provider Business Practice Location Address City Name: 
TUKWILA
    Provider Business Practice Location Address State Name: 
WA
    Provider Business Practice Location Address Postal Code: 
98188-2441
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
206-444-7939
    Provider Business Practice Location Address Fax Number: 
206-444-7810
    Provider Enumeration Date: 
09/02/2011