Provider First Line Business Practice Location Address: 
16251 SYLVESTER RD SW
    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: 
98166-3017
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
206-244-9970
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/06/2020