Provider First Line Business Practice Location Address:
13030 MILITARY RD S
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
TUKWILA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98168-3085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-310-4264
Provider Business Practice Location Address Fax Number:
206-479-7216
Provider Enumeration Date:
01/14/2011