Provider First Line Business Practice Location Address:
15627 47TH 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:
98188-2716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-439-1824
Provider Business Practice Location Address Fax Number:
206-439-1824
Provider Enumeration Date:
12/31/2006