Provider First Line Business Practice Location Address:
15675 8TH AVENUE S
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:
98148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-433-2369
Provider Business Practice Location Address Fax Number:
206-277-5960
Provider Enumeration Date:
06/12/2007