Provider First Line Business Practice Location Address:
401 SW 153RD ST
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:
98166-2247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-244-1780
Provider Business Practice Location Address Fax Number:
206-433-4060
Provider Enumeration Date:
09/14/2006