Provider First Line Business Practice Location Address:
1511 AMBAUM BLVD SOUTH WEST
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-327-9880
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2014