Provider First Line Business Practice Location Address:
13035 GATEWAY DR S
Provider Second Line Business Practice Location Address:
SUITE 131
Provider Business Practice Location Address City Name:
TUKWILA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98168-3395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-246-1281
Provider Business Practice Location Address Fax Number:
206-246-2737
Provider Enumeration Date:
10/11/2006