Provider First Line Business Practice Location Address:
31260 PACIFIC HWY S STE 9
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:
98003-5448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-528-0172
Provider Business Practice Location Address Fax Number:
253-528-0173
Provider Enumeration Date:
06/30/2009