Provider First Line Business Practice Location Address:
33507 9TH AVE S
Provider Second Line Business Practice Location Address:
BLDG B. STE 2
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-6397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-719-8554
Provider Business Practice Location Address Fax Number:
253-854-8673
Provider Enumeration Date:
09/07/2012