Provider First Line Business Practice Location Address:
33515 10TH PL S STE 10
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:
98003-7300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-941-3996
Provider Business Practice Location Address Fax Number:
253-941-3996
Provider Enumeration Date:
02/12/2008