Provider First Line Business Practice Location Address:
31002 14TH AVE S
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:
98003-4712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-941-0156
Provider Business Practice Location Address Fax Number:
253-941-1871
Provider Enumeration Date:
02/22/2007