Provider First Line Business Practice Location Address:
33507 9TH AVE S
Provider Second Line Business Practice Location Address:
SUITE C-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:
98003-6397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-347-2579
Provider Business Practice Location Address Fax Number:
253-288-2320
Provider Enumeration Date:
09/08/2008