Provider First Line Business Practice Location Address:
13512 AMBAUM BLVD SW
Provider Second Line Business Practice Location Address:
#100
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98146-3168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-324-7546
Provider Business Practice Location Address Fax Number:
206-324-7547
Provider Enumeration Date:
09/20/2006