Provider First Line Business Practice Location Address:
5341 S 140TH 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:
98168-4562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-246-8453
Provider Business Practice Location Address Fax Number:
253-735-0504
Provider Enumeration Date:
11/06/2014