Provider First Line Business Practice Location Address:
15425 53RD AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUKWILA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98188-2338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-575-9150
Provider Business Practice Location Address Fax Number:
206-575-9153
Provider Enumeration Date:
10/23/2009