Provider First Line Business Practice Location Address:
12459 AMBAUM BLVD SOUTHWEST
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:
98146-2660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-242-4961
Provider Business Practice Location Address Fax Number:
206-242-7644
Provider Enumeration Date:
11/10/2006