Provider First Line Business Practice Location Address:
200 ANDOVER PARK EAST
Provider Second Line Business Practice Location Address:
SUITE 6
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:
206-575-3182
Provider Business Practice Location Address Fax Number:
206-575-0509
Provider Enumeration Date:
08/02/2006