Provider First Line Business Practice Location Address:
15675 AMBAUM BLVD 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:
98166-2523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-433-2125
Provider Business Practice Location Address Fax Number:
206-433-2117
Provider Enumeration Date:
10/29/2012