Provider First Line Business Practice Location Address:
13102 16TH AVE 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:
98146-3041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-939-9654
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2026