Provider First Line Business Practice Location Address:
120 SW 160TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-3025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-234-4803
Provider Business Practice Location Address Fax Number:
206-242-0162
Provider Enumeration Date:
05/14/2007