Provider First Line Business Practice Location Address:
34507 PACIFIC HWY S STE 6
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:
98003-6879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-838-2464
Provider Business Practice Location Address Fax Number:
253-838-4991
Provider Enumeration Date:
09/13/2006