Provider First Line Business Practice Location Address:
18010 8TH AVE S
Provider Second Line Business Practice Location Address:
SUITE 416
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:
206-631-7316
Provider Business Practice Location Address Fax Number:
206-631-7339
Provider Enumeration Date:
09/20/2010