Provider First Line Business Practice Location Address:
34310 9TH AVE S STE 104
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-248-1470
Provider Business Practice Location Address Fax Number:
541-343-3034
Provider Enumeration Date:
04/10/2008