Provider First Line Business Practice Location Address:
34616 11TH PL S STE 1
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:
98003-8705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-661-5686
Provider Business Practice Location Address Fax Number:
253-815-1651
Provider Enumeration Date:
03/17/2010