Provider First Line Business Practice Location Address:
426 SW 153RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-2215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-243-9378
Provider Business Practice Location Address Fax Number:
206-248-1425
Provider Enumeration Date:
06/14/2005