Provider First Line Business Practice Location Address:
28815 PACIFIC HWY S
Provider Second Line Business Practice Location Address:
STE 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:
98003-3876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-941-7074
Provider Business Practice Location Address Fax Number:
253-941-5079
Provider Enumeration Date:
04/24/2007