Provider First Line Business Practice Location Address:
14249 AMBAUM BLVD SW
Provider Second Line Business Practice Location Address:
R
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-1421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-431-8559
Provider Business Practice Location Address Fax Number:
206-444-0406
Provider Enumeration Date:
07/30/2007