Provider First Line Business Practice Location Address:
4800 S 188TH ST STE 240
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATAC
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98188-4680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-841-4704
Provider Business Practice Location Address Fax Number:
425-955-7877
Provider Enumeration Date:
11/19/2025