Provider First Line Business Practice Location Address:
15515 3RD AVE SW
Provider Second Line Business Practice Location Address:
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:
98166-2553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-246-8990
Provider Business Practice Location Address Fax Number:
206-246-8699
Provider Enumeration Date:
07/26/2006