Provider First Line Business Practice Location Address:
32300 1ST AVENUE SOUTH
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:
253-874-3580
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2007