Provider First Line Business Practice Location Address:
16110 8TH AVE SW
Provider Second Line Business Practice Location Address:
SUITE C2
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-2962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-242-7822
Provider Business Practice Location Address Fax Number:
206-244-2133
Provider Enumeration Date:
07/02/2006