Provider First Line Business Practice Location Address:
1210 SW 136TH ST
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:
98166-1214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-257-6758
Provider Business Practice Location Address Fax Number:
206-933-7005
Provider Enumeration Date:
10/14/2014