Provider First Line Business Practice Location Address:
15410 AMBAUM BLVD SW
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:
98166-2402
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:
12/15/2010