Provider First Line Business Practice Location Address:
6720 FORT DENT WAY
Provider Second Line Business Practice Location Address:
SUITE #210
Provider Business Practice Location Address City Name:
TUKWILA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-433-5595
Provider Business Practice Location Address Fax Number:
206-433-0537
Provider Enumeration Date:
09/11/2006