Provider First Line Business Practice Location Address:
34509 9TH AVE S
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-6700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-572-5140
Provider Business Practice Location Address Fax Number:
253-272-0419
Provider Enumeration Date:
01/09/2007