Provider First Line Business Practice Location Address:
415 BAKER BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
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:
206-439-8828
Provider Business Practice Location Address Fax Number:
206-439-8878
Provider Enumeration Date:
11/02/2006