Provider First Line Business Practice Location Address:
14212 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:
98166-1449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-217-4530
Provider Business Practice Location Address Fax Number:
206-217-4533
Provider Enumeration Date:
11/08/2011