Provider First Line Business Practice Location Address:
7200 S 180TH ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
TUKWILA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98188-5548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-774-1538
Provider Business Practice Location Address Fax Number:
425-774-5171
Provider Enumeration Date:
01/04/2013