Provider First Line Business Practice Location Address:
14220 INTERURBAN AVE S
Provider Second Line Business Practice Location Address:
SUITE A110
Provider Business Practice Location Address City Name:
TUKWILA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98168-4662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-439-1710
Provider Business Practice Location Address Fax Number:
206-439-6880
Provider Enumeration Date:
04/06/2009