Provider First Line Business Practice Location Address:
34004 9TH AVE S
Provider Second Line Business Practice Location Address:
STE A9
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-6737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-517-8556
Provider Business Practice Location Address Fax Number:
253-517-8556
Provider Enumeration Date:
05/25/2011