Provider First Line Business Practice Location Address:
929 SW 152ND ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-1843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-431-3171
Provider Business Practice Location Address Fax Number:
206-242-7330
Provider Enumeration Date:
01/22/2007