Provider First Line Business Practice Location Address:
14247 R AMBAUM BLVD SW
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:
98166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-244-4488
Provider Business Practice Location Address Fax Number:
206-242-2367
Provider Enumeration Date:
09/13/2006