Provider First Line Business Practice Location Address:
34618 11TH AVE. S.
Provider Second Line Business Practice Location Address:
SUITE 100
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:
253-336-4512
Provider Business Practice Location Address Fax Number:
253-838-4145
Provider Enumeration Date:
12/15/2014