Provider First Line Business Practice Location Address:
33305 1ST WAY S STE B104
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:
98003-4545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-252-2415
Provider Business Practice Location Address Fax Number:
253-235-5681
Provider Enumeration Date:
06/15/2007