Provider First Line Business Practice Location Address:
15410 AMBAUM BLVD. S.W.
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-1437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-248-3414
Provider Business Practice Location Address Fax Number:
206-244-6755
Provider Enumeration Date:
10/02/2006