Provider First Line Business Practice Location Address:
13610 1ST AVE SOUTH
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:
98168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-248-5020
Provider Business Practice Location Address Fax Number:
206-244-8425
Provider Enumeration Date:
10/30/2018