Provider First Line Business Practice Location Address:
14900 INTERURBAN AVE S
Provider Second Line Business Practice Location Address:
SUITE 271
Provider Business Practice Location Address City Name:
TUKWILA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98168-4635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-220-9628
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2007