Provider First Line Business Practice Location Address:
33515 10TH PL S STE 16
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:
253-838-2326
Provider Business Practice Location Address Fax Number:
253-838-5781
Provider Enumeration Date:
11/06/2006