Provider First Line Business Practice Location Address:
13955 INTERURBAN AVE SO
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-431-0953
Provider Business Practice Location Address Fax Number:
206-439-6860
Provider Enumeration Date:
01/30/2007