Provider First Line Business Practice Location Address:
1411 SOUTH 348TH STREET
Provider Second Line Business Practice Location Address:
BUILDING L SUITE 104
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-8373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-874-2000
Provider Business Practice Location Address Fax Number:
253-874-5207
Provider Enumeration Date:
08/05/2006