Provider First Line Business Practice Location Address:
34515 9TH AVE S
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:
98003-6761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-426-6753
Provider Business Practice Location Address Fax Number:
253-426-6014
Provider Enumeration Date:
07/16/2007