Provider First Line Business Practice Location Address:
34509 9TH AVE. SOUTH
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-8707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-815-7774
Provider Business Practice Location Address Fax Number:
253-815-7708
Provider Enumeration Date:
06/26/2006