Provider First Line Business Practice Location Address:
13030 MILITARY ROAD S
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
TUKWILA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-439-3289
Provider Business Practice Location Address Fax Number:
206-439-3273
Provider Enumeration Date:
12/19/2011