Provider First Line Business Practice Location Address:
33600 6TH AVE S
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-6743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-661-2502
Provider Business Practice Location Address Fax Number:
253-874-5635
Provider Enumeration Date:
08/04/2006