Provider First Line Business Practice Location Address:
14900 INTERURBAN 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:
98168-4635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-693-9202
Provider Business Practice Location Address Fax Number:
206-248-1160
Provider Enumeration Date:
06/10/2016