Provider First Line Business Practice Location Address:
34616 11TH PL S
Provider Second Line Business Practice Location Address:
#3
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-8705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-874-5148
Provider Business Practice Location Address Fax Number:
253-874-4228
Provider Enumeration Date:
09/09/2005