Provider First Line Business Practice Location Address:
225 S 152ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98148-1005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-870-3623
Provider Business Practice Location Address Fax Number:
206-299-3496
Provider Enumeration Date:
05/23/2006