Provider First Line Business Practice Location Address:
14432 MILITARY RD S STE 3
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:
98168-5303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-242-2881
Provider Business Practice Location Address Fax Number:
206-242-2880
Provider Enumeration Date:
08/18/2006