Provider First Line Business Practice Location Address:
149 S 140TH ST
Provider Second Line Business Practice Location Address:
#210
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98168-3435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-323-2737
Provider Business Practice Location Address Fax Number:
206-988-5136
Provider Enumeration Date:
03/19/2012