Provider First Line Business Practice Location Address:
16110 8TH AVE SW
Provider Second Line Business Practice Location Address:
STE B1
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-2963
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-248-5020
Provider Business Practice Location Address Fax Number:
206-244-8425
Provider Enumeration Date:
06/14/2005