Provider First Line Business Practice Location Address:
5216 S 142ND ST
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:
98168-4462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-386-1748
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2024