Provider First Line Business Practice Location Address:
14900 INTERURBAN AVE S STE 269
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:
98168-4635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-701-9799
Provider Business Practice Location Address Fax Number:
206-701-9939
Provider Enumeration Date:
12/15/2025