Provider First Line Business Practice Location Address:
33507 9TH AVE. S.
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-6397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-874-5404
Provider Business Practice Location Address Fax Number:
253-874-8964
Provider Enumeration Date:
03/23/2006