Provider First Line Business Practice Location Address:
820 SW 148TH 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:
98166-1835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-223-3644
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/25/2025