Provider First Line Business Practice Location Address:
15811 AMBAUM BLVD SW
Provider Second Line Business Practice Location Address:
#170 (SUITE A)
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-3066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-439-2988
Provider Business Practice Location Address Fax Number:
206-431-3939
Provider Enumeration Date:
06/22/2006