Provider First Line Business Practice Location Address:
13014 12TH AVE SW
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:
98146-3110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-244-5805
Provider Business Practice Location Address Fax Number:
206-248-7362
Provider Enumeration Date:
11/08/2005