Provider First Line Business Practice Location Address:
30816 PACIFIC HWY S
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:
98003-4902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-835-0055
Provider Business Practice Location Address Fax Number:
253-835-0055
Provider Enumeration Date:
03/22/2007