Provider First Line Business Practice Location Address:
34507 PACIFIC HWY S STE 4
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:
98003-6879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-874-4141
Provider Business Practice Location Address Fax Number:
253-874-3601
Provider Enumeration Date:
02/27/2007