Provider First Line Business Practice Location Address:
33606 PACIFIC HWY S
Provider Second Line Business Practice Location Address:
#4
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-6874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-838-1235
Provider Business Practice Location Address Fax Number:
253-838-4254
Provider Enumeration Date:
08/15/2007