Provider First Line Business Practice Location Address:
12402 14TH AVE 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:
98146-2617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-244-6219
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2005