Provider First Line Business Practice Location Address:
138 SW 148TH 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:
98166-1924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-243-2796
Provider Business Practice Location Address Fax Number:
206-248-8361
Provider Enumeration Date:
06/21/2006