Provider First Line Business Practice Location Address:
15625 42ND AVE S
Provider Second Line Business Practice Location Address:
E24
Provider Business Practice Location Address City Name:
TUKWILA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98188-2658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-579-1668
Provider Business Practice Location Address Fax Number:
206-246-4686
Provider Enumeration Date:
11/23/2006