Provider First Line Business Practice Location Address:
116 SW 148TH ST
Provider Second Line Business Practice Location Address:
D100
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-1983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-426-7999
Provider Business Practice Location Address Fax Number:
206-246-7788
Provider Enumeration Date:
07/12/2012