Provider First Line Business Practice Location Address:
6839 FORT DENT WAY STE 134
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:
98188-2597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-812-9988
Provider Business Practice Location Address Fax Number:
206-812-9989
Provider Enumeration Date:
12/02/2013