Provider First Line Business Practice Location Address:
33427 PAC. HWY. S.
Provider Second Line Business Practice Location Address:
C-1
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-874-2498
Provider Business Practice Location Address Fax Number:
253-248-1909
Provider Enumeration Date:
07/24/2009