Provider First Line Business Practice Location Address:
30806 PACIFIC HWY S STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-4902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-720-3559
Provider Business Practice Location Address Fax Number:
253-528-0063
Provider Enumeration Date:
05/29/2007