Provider First Line Business Practice Location Address:
14212 AMBAUM BLVD
Provider Second Line Business Practice Location Address:
SW #305
Provider Business Practice Location Address City Name:
BURIEM
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:
206-988-3968
Provider Business Practice Location Address Fax Number:
206-988-3969
Provider Enumeration Date:
03/01/2007