Provider First Line Business Practice Location Address:
33720 9TH AVE S
Provider Second Line Business Practice Location Address:
#B-4
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-6735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-874-1467
Provider Business Practice Location Address Fax Number:
253-874-2019
Provider Enumeration Date:
03/13/2007