Provider First Line Business Practice Location Address:
207 SW 156TH STREET
Provider Second Line Business Practice Location Address:
SUITE #4
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-2561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-246-1424
Provider Business Practice Location Address Fax Number:
206-246-1648
Provider Enumeration Date:
04/04/2007