Provider First Line Business Practice Location Address:
15623 1ST AVE S
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98148-1292
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-444-6320
Provider Business Practice Location Address Fax Number:
206-444-6302
Provider Enumeration Date:
09/24/2008