Provider First Line Business Practice Location Address:
207 SW 156TH ST
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-2561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-244-4545
Provider Business Practice Location Address Fax Number:
206-244-0336
Provider Enumeration Date:
10/12/2006