Provider First Line Business Practice Location Address:
32015 1ST AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-5701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-927-9382
Provider Business Practice Location Address Fax Number:
253-661-3284
Provider Enumeration Date:
04/05/2007