Provider First Line Business Practice Location Address:
31625 PACIFIC HWY S SPACE
Provider Second Line Business Practice Location Address:
PAVILLIONS II CTR AT FEDERAL WAY STE #E1
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-5645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-946-4387
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2006