Provider First Line Business Practice Location Address:
34509 9TH AVE S
Provider Second Line Business Practice Location Address:
SUITE 309
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-661-1814
Provider Business Practice Location Address Fax Number:
253-661-1489
Provider Enumeration Date:
05/09/2006