Provider First Line Business Practice Location Address:
33915 1ST WAY S
Provider Second Line Business Practice Location Address:
SUITE #201
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-4551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-927-6411
Provider Business Practice Location Address Fax Number:
253-252-2804
Provider Enumeration Date:
04/18/2007