Provider First Line Business Practice Location Address:
3480 S 152ND 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:
98188-2142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-246-0733
Provider Business Practice Location Address Fax Number:
206-244-7897
Provider Enumeration Date:
12/04/2006