Provider First Line Business Practice Location Address:
32020 1ST AVE S
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-5717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-943-1603
Provider Business Practice Location Address Fax Number:
253-943-1604
Provider Enumeration Date:
08/19/2008