Provider First Line Business Practice Location Address:
33919 9TH AVE S
Provider Second Line Business Practice Location Address:
#201
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:
253-927-6616
Provider Business Practice Location Address Fax Number:
253-874-4733
Provider Enumeration Date:
12/28/2006