Provider First Line Business Practice Location Address:
33505 13TH PL S STE C
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:
98003-6337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-246-2433
Provider Business Practice Location Address Fax Number:
253-838-1433
Provider Enumeration Date:
10/09/2014