Provider First Line Business Practice Location Address:
13925 INTERURBAN AVE S STE 120
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:
98168-5718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-948-0096
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2007