Provider First Line Business Practice Location Address:
14242 AMBAUM BLVD SW
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-1448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-242-8080
Provider Business Practice Location Address Fax Number:
206-242-2339
Provider Enumeration Date:
07/14/2016