Provider First Line Business Practice Location Address:
34709 9TH AVE S
Provider Second Line Business Practice Location Address:
STE A-100
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-8722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-952-3887
Provider Business Practice Location Address Fax Number:
253-927-3058
Provider Enumeration Date:
03/19/2007