Provider First Line Business Practice Location Address:
30115 2ND PL SW
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:
98023-3971
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-979-2943
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2006