Provider First Line Business Practice Location Address:
33516 9TH AVE S
Provider Second Line Business Practice Location Address:
WESTHILL COURT BLDG 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:
98003-6322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-941-6242
Provider Business Practice Location Address Fax Number:
253-952-2129
Provider Enumeration Date:
11/28/2005