Provider First Line Business Practice Location Address:
12844 MILITARY RD S
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-248-4604
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2006