Provider First Line Business Practice Location Address:
14212 AMBAUM BLVD. SW
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-762-8433
Provider Business Practice Location Address Fax Number:
206-767-5581
Provider Enumeration Date:
11/01/2013