Provider First Line Business Practice Location Address:
30620 PACIFIC HWY S STE 111
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:
98003-4888
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-946-3895
Provider Business Practice Location Address Fax Number:
253-946-8596
Provider Enumeration Date:
03/15/2007