Provider First Line Business Practice Location Address:
200 S 333RD ST
Provider Second Line Business Practice Location Address:
STE 150
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-7391
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-275-6030
Provider Business Practice Location Address Fax Number:
253-946-0428
Provider Enumeration Date:
10/21/2008