Provider First Line Business Practice Location Address:
15217 8TH AVE S
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98148-2566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-242-0920
Provider Business Practice Location Address Fax Number:
206-242-0987
Provider Enumeration Date:
05/07/2007