Provider First Line Business Practice Location Address:
916 SW 152ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-1844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-242-4737
Provider Business Practice Location Address Fax Number:
206-242-3880
Provider Enumeration Date:
12/28/2010