Provider First Line Business Practice Location Address:
630 SW 149TH ST STE 101
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:
98166-1958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-244-2471
Provider Business Practice Location Address Fax Number:
206-241-7677
Provider Enumeration Date:
06/05/2006