Provider First Line Business Practice Location Address:
34616 11TH PL S
Provider Second Line Business Practice Location Address:
SUITE # 6
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:
253-874-9430
Provider Business Practice Location Address Fax Number:
253-924-1548
Provider Enumeration Date:
12/04/2005