Provider First Line Business Practice Location Address:
34503 9TH AVE S STE 230
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:
98003-8726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-838-3103
Provider Business Practice Location Address Fax Number:
253-838-7134
Provider Enumeration Date:
04/30/2012