Provider First Line Business Practice Location Address:
12459 AMBAUM BLVD S.W.
Provider Second Line Business Practice Location Address:
UNIT A
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-403-1819
Provider Business Practice Location Address Fax Number:
206-588-2752
Provider Enumeration Date:
12/30/2009