Provider First Line Business Practice Location Address:
801 SW 150TH ST
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-1855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-331-1442
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2007