Provider First Line Business Practice Location Address:
14400 AMBAUM BLVD SW
Provider Second Line Business Practice Location Address:
SUITE Q
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-1446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-244-0956
Provider Business Practice Location Address Fax Number:
206-244-1017
Provider Enumeration Date:
09/19/2007