Provider First Line Business Practice Location Address:
12644 INTERURBAN AVE SOUTH,
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:
425-654-0887
Provider Business Practice Location Address Fax Number:
425-209-0091
Provider Enumeration Date:
03/09/2021