Provider First Line Business Practice Location Address:
4404 S 160TH 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:
98188-2755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-353-2768
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2009