Provider First Line Business Practice Location Address:
34709 9TH AVE S
Provider Second Line Business Practice Location Address:
SUITE B-300
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-8722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-874-2583
Provider Business Practice Location Address Fax Number:
253-874-2583
Provider Enumeration Date:
10/08/2008