Provider First Line Business Practice Location Address:
920 SW 152ND ST
Provider Second Line Business Practice Location Address:
SUITE #101
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-1884
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-870-1990
Provider Business Practice Location Address Fax Number:
253-572-8046
Provider Enumeration Date:
12/11/2007