Provider First Line Business Practice Location Address:
407 BAKER BLVD
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:
98188-2906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-246-5430
Provider Business Practice Location Address Fax Number:
206-246-7826
Provider Enumeration Date:
10/18/2007